Post-thyroidectomy voice and swallowing therapy

Sounderic
Jun 27, 2022
5 min read

Updated: Sep 23

What is Thyroidectomy?

Thyroidectomy is a surgical procedure in which either complete or partial removal of the thyroid gland is performed by a surgeon under general anesthesia.

The thyroid is a gland situated in the neck which controls all the activities of a human body from the rate of heartbeat to metabolism. While the surgery is often lifesaving—especially for thyroid cancer, goiters, or nodules—it can come with side effects that affect voice and swallowing functions.

Because the thyroid sits near critical nerves that control vocal fold movement and swallowing, patients often experience hoarseness, vocal fatigue, or difficulty swallowing post-surgery. These problems, if not addressed, can affect nutrition, communication, and overall quality of life.

This is where a Speech-Language Pathologist (SLP) plays an essential role—helping patients recover voice and swallowing functions safely and effectively.

Why is Thyroidectomy Performed?

Thyroidectomy may be recommended for:

Thyroid cancer
Non-cancerous goiter (enlargement of thyroid gland)
Thyroid nodules (suspicious or symptomatic growths)
Neck mass/enlargement causing breathing or swallowing difficulties

Types of Thyroidectomy:

Partial thyroidectomy – removal of one lobe.
Total thyroidectomy – removal of the entire gland.

Find here some of the best thyroidectomy hospitals in India

Common Problems After Thyroidectomy

Dysphonia (Voice Problems)

Hoarseness or breathiness
Vocal fatigue with speaking
Pitch changes or loss of range
Difficulty projecting voice

Cause: Often linked to recurrent laryngeal nerve (RLN) injury or vocal fold paralysis.

Dysphagia (Swallowing Problems)

Trouble swallowing solids or liquids
Coughing or choking during meals
Risk of aspiration pneumonia
Malnutrition or weight loss if untreated

Cause: Nerve injury, intubation trauma, or anatomical/functional changes in larynx and pharynx.

It is advised to do a pre-operative assessment of voice and swallowing when thyroidectomy is planned just before the surgery.

Speech-Language pathologist plays a major role in treating Dysphonia and Dysphagia.

SLPs support patients in both the pre-operative and post-operative phases.

Pre-operative assessment: Establishes a baseline for voice and swallowing function (e.g., acoustic voice analysis, water swallow test).
Counseling: Educates patients about potential changes and sets realistic expectations.
Post-operative therapy: Provides targeted voice therapy and swallowing rehabilitation to restore safe and functional communication and nutrition.
Collaboration: Works alongside surgeons, oncologists, and dietitians as part of a multidisciplinary team.

CC: Thyroid Surgery Recovery, Side Effects, and Complications

How can a speech-language pathologist help during the pre-operative period?

During the pre-operative period, one should be explained about complications post-surgery. Though there are several surgical options available to treat vocal fold paralysis, speech pathologists have experience in providing voice therapy and swallowing therapy which in turn can improve voice as well as swallowing abilities.

If treatment for dysphagia and dysphonia (hoarseness of voice) isn't started as early as possible, this could lead to malnutrition, and aspiration pneumonia, and also leads to the inability to communicate respectively. However, appropriate treatment by the speech-language pathologist post thyroidectomy at the correct time would benefit the individual from many such problems.

Pre-operative voice assessment works as a baseline assessment for an individual which can also be taken up as that particular individual's normative that needs to be achieved post-surgery.

Pre-therapy assessment is essential for establishing the treatment goals and appropriate procedures for each patient as patients who have the same diagnosis may have different symptoms and different responses to therapy.

Acoustic analysis of voice and water swallow tests are the basic tests performed in the pre-operative assessment of voice and swallow respectively.

Why Do Voice and Swallowing Problems Occur Post-Surgery?

Recurrent laryngeal nerve palsy (temporary or permanent)
Vocal fold paralysis or weakness → breathy, weak voice, aspiration risk
Intubation trauma during anesthesia
Anatomical/functional changes in larynx and pharynx

Symptoms Requiring Therapy:

Persistent hoarseness or breathy/weak voice
Early vocal fatigue or reduced loudness
Difficulty swallowing liquids/solids
Frequent coughing or choking when eating
Sensation of food “sticking” in the throat

What leads to hoarseness of voice post-thyroidectomy?

About 10% of patients experience voice disturbance directly due to (usually) temporary and (rarely) permanent laryngeal nerve injuries after surgery.

Voice problems post-thyroidectomy include breathiness with loss of air during vocalization, change in pitch, inability to project the voice, and early vocal fatigue, any and all of which can impair communication.

“Voice problems after thyroid surgery can significantly reduce quality of life,” says Sujana S. Chandrasekhar, MD. “Surgeons need to realize the importance of evaluating voice in thyroid surgery patients. Early diagnosis and treatment can result in much better outcomes. Physicians should not take a wait-and-see approach.”

Vocal fold paralysis post thyroidectomy often causes insufficient glottic closure which can then cause

Dysphonic symptoms such as weakness, breathiness, reduced voice range, and loudness.
Vocal fold paralysis can also cause dysphagic symptoms such as coughing, choking, and aspiration pneumonia.
Because patients who have received thyroidectomy often have difficulty swallowing, another possible outcome is malnutrition.

The main goal of voice therapy is to restore voice using voice therapy techniques. Vocal hygiene and counseling play a major role in voice therapy. Usually, voice therapy is required for multiple sessions and must be performed by a speech-language pathologist with expertise in Voice disorders.

Treatment: Voice Therapy After Thyroidectomy

Goals:

Restore safe, functional voice
Improve vocal fold closure
Prevent compensatory strain

Techniques:

Vocal hygiene & counseling (hydration, reducing throat clearing)
Chant talk and resonant voice therapy
Ear training and head positioning techniques
Push–pull approach to facilitate glottic closure
Vocal Function Exercises (VFEs): evidence-based exercises to strengthen vocal folds and improve range and stamina

Therapy usually requires multiple sessions with a trained SLP for best outcomes.

Treatment: Swallowing Therapy After Thyroidectomy

Most often patients with thyroidectomy complain of the pharyngeal phase of Dysphagia. The main aim of swallowing therapy is to protect the individual from aspiration pneumonia and malnutrition.

Goals:

Safely restore swallowing
Prevent aspiration pneumonia and malnutrition

Techniques:

Swallowing maneuvers: chin tuck, head rotation/tilt, effortful swallow, supraglottic swallow, oral hold.
Diet modifications: altering bolus size, consistency, and texture.
Strengthening exercises: head and neck range-of-motion and relaxation routines.
Postural adjustments: to guide safe swallowing.

Special Considerations & Patient Advice

Begin therapy only after physician clearance and wound healing.
Avoid heavy lifting for 2 weeks post-surgery.
Perform gentle neck stretching to reduce stiffness.
Avoid swimming/baths for at least a week.
Avoid driving until neck mobility and medication effects allow.
Report red flag symptoms: worsening hoarseness, persistent aspiration, or difficulty breathing.

FAQs: Voice and Swallowing Problems After Thyroid Surgery

1. How long do hoarseness and swallowing issues last?

Most are temporary (weeks to months), but nerve injuries may cause longer-lasting problems.

2. Will everyone need speech/swallowing therapy after thyroidectomy?

No, only those who experience voice or swallowing changes—but early evaluation is always recommended.

3. Can nerve injury from surgery recover?

Yes, many temporary nerve injuries heal within 6–12 months. Permanent paralysis requires ongoing therapy or surgical interventions.

4. Is voice therapy effective for permanent vocal fold paralysis?

Yes—therapy can significantly improve voice quality, reduce fatigue, and teach compensatory strategies.

5. When should therapy begin?

Ideally within weeks of surgery, after medical clearance, to prevent maladaptive patterns.

6. Is online SLP support effective for post-thyroidectomy recovery?

Yes—Sounderic’s Online Therapy provides expert guidance for both voice and swallowing rehabilitation from the comfort of your home.

If you or a loved one is planning a thyroidectomy surgery or is experiencing difficulties with swallowing and voice post thyroidectomy, feel free to reach out to our experienced speech-language pathologists for a consultation and steps ahead.

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